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RC-17-919L I Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 1022 NE 91 Terrace Miami Shores, FL Owner Information JENNIFER JORDAN Permit Permit NO. RC -4-17-919 Permit Type: Residential Construction Work Classification: Alteration Permit Status: APPROVED Issue Date: 4/712017 Expiration: 10/04/2017 Parcel Number Applicant Address 1022 NE 91 Terrace MIAMI SHORES FL 33138- Contractor(s) Phone CeII Phone ELTEC CONSTRUCTION & INVESTME (305)694-1080 (786)444-5703 Phone (386)986-9440 CeII Valuation: Total Sq Feet: $ 4,000.00 0 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: KTICHEN REMODELING AND RETI Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: Bond Return : Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $2.40 $2.00 $2.00 $0.80 $5.00 $120.00 $9.00 $3.20 $144.40 Pay Date Pay Type Invoice # RC -4-17-63560 04/04/2017 Check #: 397 04/07/2017 Credit Card Amt Paid Amt Due $ 50.00 $ 94.40 $ 94.40 $ 0.00 Available Inspections: Inspection Type: Final PE Certification Window Door Attachment Framing Insulation Drywall Screw Fill Cells Columns Window and Door Buck Review Planning Review Electrical Review Building Review Plumbing Review Structural Review Mechanical , In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo tnermore, a the above-named contractor to do the work stated. Authorize / Applicant / Contractor / Agent Building Department Copy April 07, 2017 Date April 07, 2017 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 NOTICE OF VIOLATION ljb- i5-10 Rc- 11 67 DATE: March 17, 2017 TO: Jennifer Jordan 25 l v , o V I ()c-' . Z fi 12 1022 NE 91 Terr. Miami Shores, Florida 33138-3402 RE: Work Without Permit Jennifer Jordan 1022 NE 91 Terr. Miami Shores, Florida 33138-3402 FOLIO: 11-3205-001-0300 Legal Description: Westersedge PB 9-141, lot 3 & E15 ft. Lot 2 BLK 2 YOU ARE HEREBY NOTIFIED that an inspection of the above premises revealed that you have violated the provisions of the Florida Building Code which have been adopted as the uniform building code for Miami Shores Village, Florida or provisions of the Code of Miami -Dade County. Type of Violation: Building, Electrical, Mechanical, and Plumbing. Chapter: 1 Section: 105.1 of the 5th Edition of the 2014 Florida Building Code To Witt: Failure to obtain permits for interior renovation and garage enclosure. REQUIREMENTS FOR CORRECTION Provide plans with details and specifications as required under section 107.2 of the 5111 Edition of the 2014 Florida Building Code and chapter 8-10 of the Miami Dade County Code. The scope of work should be approved by outside agencies and by the Miami Shores Village Planning and Zoning. Therefore, you are hereby directed that on or before Monday, April 11, 2016 you are to correct said VIOLATION and NOTIFY THE UNDERSIGNED BUILDING INSPECTOR that the VIOLATION has been corrected. Failure to make the correction(s) will result in one or more of the following actions: Disconnect utilities services, issuance of a ticket(s) in the amount of $500.00 or more, filing of a civil suit or criminal charges against you or initiation of an unsafe structures case requiring demolition of the structure. Also, failure to comply with this notice may result in the department withholding issuance of other permits to you, referral of this matter to the appropriate licensing board or the filing of a lien against your property in the amount of any unpaid ticketing fines. In accordance with the provisions of Section 8-17 of the Code of Miami -Dade County, you are also responsible for the reasonable costs and expenses incurred by the Building Official in enforcing the provisions of the Building Code. In the event further clarification or assistance is required, please contact Ismael Naranjo, B.O at (305) 795-2204 between the hours of 8:30 A.M. and 5:00 PM. Except in the case of life -safety hazards, you may be granted upon request an extension of time up to 90 days to correct the violation provided your request is submitted prior to the expiration of this Notice of Violation and enforcement costs incurred by the department to date are paid in full. To request an extension, please contact the Building Department by telephone at (305) 795-2207 or by e-mail to naranjoi@miamishoresvillage.com. Thankur cooperation in this matter. Ismael Naranjo, B.O Building Director. Mail By: Date Mailed: 3 (2-1 (14. Posted By: Return Receipt Number: Date Posted: CC: Mr. Elrod Phillips, CEO Eltec Construction & Investment Liquidation Group, 2400 NW 98th St. Miami, Florida 33147 *Z cxo l • ZS ( )L O l . '4 i . ?A19 U.S. Postal Service` • 0-7.1.: CERTIFIED MAIL'RECEIP..T: (Domestic Mail ,.Only No Insurance Coverage Provided) rm. x,ni {*w Ir OFFICIAL USE Postage Certified Fee Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) Total Postage & Fees Sent T Postmark Here PS Furrn 3800, January 7001 Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) Total Postage & Fees Postmark Here Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 NOTICE OF VIOLATION DATE: March 17, 2017 TO: Jennifer Jordan 1022 NE 91 Terr. Miami Shores, Florida 33138-3402 RE: Work Without Permit Jennifer Jordan 1022 NE 91 Terr. Miami Shores, Florida 33138-3402 FOLIO: 11-3205-001-0300 Legal Description: Westersedge PB 9-141, lot 3 & E 15 ft. Lot 2 BLK 2 cL-,(0)1(1° 1. YOU ARE HEREBY NOTIFIED that an inspection of the above premises revealed that you have violated the provisions of the Florida Building Code which have been adopted as the uniform building code for Miami Shores Village, Florida or provisions of the Code of Miami -Dade County. Type of Violation: Building, Electrical, Mechanical, and Plumbing. Chapter: 1 Section: 105.1 of the 5th Edition of the 2014 Florida Building Code To Witt: Failure to obtain permits for interior renovation and garage enclosure. REQUIREMENTS FOR CORRECTION Provide plans with details and specifications as required under section 107.2 of the 5TH Edition of the 2014 Florida Building Code and chapter 8-10 of the Miami Dade County Code. The scope of work should be approved by outside agencies and by the Miami Shores Village Planning and Zoning. Therefore, you are hereby directed that on or before Monday, April 11, 2016 you are to correct said VIOLATION and NOTIFY THE UNDERSIGNED BUILDING INSPECTOR that the VIOLATION has been corrected. Failure to make the correction(s) will result in one or more of the following actions: Disconnect utilities services, issuance of a ticket(s) in the amount of $500.00 or more, filing of a civil suit or criminal charges against you or initiation of an unsafe structures case requiring demolition of the structure. Also, failure to comply with this notice may result in the department withholding issuance of other permits to you, referral of this matter to the appropriate licensing board or the filing of a lien against your property in the amount of any unpaid ticketing fines. In accordance with the provisions of Section 8-17 of the Code of Miami -Dade County, you are also responsible for the reasonable costs and expenses incurred by the Building Official in enforcing the provisions of the Building Code. In the event further clarification or assistance is required, please contact Ismael Naranjo, B.O at (305) 795-2204 between the hours of 8:30 A.M. and 5:00 PM. Except in the case of life -safety hazards, you may be granted upon request an extension of time up to 90 days to correct the violation provided your request is submitted prior to the expiration of this Notice of Violation and enforcement costs incurred by the department to date are paid in full. To request an extension, please contact the Building Department by telephone at (305) 795-2207 or by e-mail to naran'oi miamishoresvilla e.com. Thank-faryur cooperation in this matter. Ismael Naranjo, B.O Building Director. Mail By: Date Mailed: Posted By: /Serxwl A)oc.60 Return Receipt Number: Date Posted: JI)J?i.c;3169 1 Mr. Elrod Phillips, CEO Eltec Construction & Investment Liquidation Group, 2400 NW 98th St. Miami, Florida 33147 SENDER: COMPLETE THIS SECTION • Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. • Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: -ELadi) P;-- LATS . G->N►,TTPkC" -16t• 4- 1 NAf R S'^Cm5-or'T 1OO Nw 'I6 Sz t a -,-,r, (=L. 3 3 COMPLETE THIS SECTION ON DELIVERY A. Signature X B. Received by (Printed Name) ❑ Agent o Addressee C. Date of Delivery D. Is delivery address different from Rem 1? If YES, enter delivery address below: 0 No 0 Yes 3. Service Type VidsCertifled Mail ❑ Registered ❑ Insured Mail ❑ Express Mail liLRetum Receipt dilWarcIasaelide ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) 0 Yes 2. Article 7001 2510 0001 0841 2099 (Transfer PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE I 0 0 i First -Class Mail Postage & Fees Paid USPS Permit No. G-10 Sender: Please print your name, address, and ZIP+4 in this box • MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N.E 2 AVENUE MIAMI SHORES, FL 33138 �G N -14 2-0 PLACE STICKER ATOP OF ENVELOPE TO THE RIGHT OF THE RETURN ADDRESS. FOLD AT DOTTEDtINE CERTIFIED MAIL ;0050 N E 2..o AVENUE F LOR I D A 33138 1 1 111 1 1 7001 2510 0001 0841 2099 ELROD PHILIPS ELTEC CONSTRUCTION & INVESTMENT 2400 NW 98 -- MIAMI, DL 3 = - US POSTAGE $ 06.736 First -Class Mailed From 33138 03/21/2016 032A 0061800478 RETURN TO SENDER UNCLAIMED UNABLE TO FORWARD BC: 33138238299 *2706-09107-21-44 fw,ci33Ta2 ,1i11il1l1",1111111111+(Hnllhilmlllllli1111ii,ii11111111ili Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 NOTICE OF VIOLATION DATE: March 17, 2017 TO: Jennifer Jordan 1022 NE 91 Terr. Miami Shores, Florida 33138-3402 RE: Work Without Permit Jennifer Jordan 1022 NE 91 Terr. Miami Shores, Florida 33138-3402 FOLIO: 11-3205-001-0300 Legal Description: Westersedge PB 9-141, lot 3 & E15 ft. Lot 2 BLK 2 YOU ARE HEREBY NOTIFIED that an inspection of the above premises revealed that you have violated the provisions of the Florida Building Code which have been adopted as the uniform building code for Miami Shores Village, Florida or provisions of the Code of Miami -Dade County. Type of Violation: Building, Electrical, Mechanical, and Plumbing. Chapter: 1 Section: 105.1 of the 5th Edition of the 2014 Florida Building Code To Witt: Failure to obtain permits for interior renovation and garage enclosure. REQUIREMENTS FOR CORRECTION Provide plans with details and specifications as required under section 107.2 of the 5TH Edition of the 2014 Florida Building Code and chapter 8-10 of the Miami Dade County Code. The scope of work should be approved by outside agencies and by the Miami Shores Village Planning and Zoning. Therefore, you are hereby directed that on or before Monday, April 11, 2016 you are to correct said VIOLATION and NOTIFY THE UNDERSIGNED BUILDING INSPECTOR that the VIOLATION has been corrected. Failure to make the correction(s) will result in one or more of the following actions: Disconnect utilities services, issuance of a ticket(s) in the amount of $500.00 or more, filing of a civil suit or criminal charges against you or initiation of an unsafe structures case requiring demolition of the structure. Also, failure to comply with this notice may result in the department withholding issuance of other permits to you, referral of this matter to the appropriate licensing board or the filing of a lien against your property in the amount of any unpaid ticketing fines. In accordance with the provisions of Section 8-17 of the Code of Miami -Dade County, you are also responsible for the reasonable costs and expenses incurred by the Building Official in enforcing the provisions of the Building Code. In the event further clarification or assistance is required, please contact Ismael Naranjo, B.O at (305) 795-2204 between the hours of 8:30 A.M. and 5:00 PM. Except in the case of life -safety hazards, you may be granted upon request an extension of time up to 90 days to correct the violation provided your request is submitted prior to the expiration of this Notice of Violation and enforcement costs incurred by the department to date are paid in full. To request an extension, please contact the Building Department by telephone at (305) 795-2207 or by e-mail to naranjoi(a,miamishoresvillage.com. Thankm;yur cooperation in this matter. V/7/P Ismael Naranjo, B.O Building Director. Mail By: re .---- Date Mailed: 31 2 i 110 Return Receipt Number: 1c01 .2Sly . Posted By: Date Posted: CC: Mr. Elrod Phillips, CEO Eltec Construction & Investment Liquidation Group, 2400 NW 98th St. Miami, Florida 33147 vu( -)k 0 s -`t1 . 2-0`11 4 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 NOTICE OF VIOLATION DATE: March 17, 2017 dJ MIAMI Ce 4 �. CI) giii7 'te Certificate in Geos ��l�fi�6�ogy mi. http://miau/gis TO: Jennifer Jordan -1 (i k . ZS 1 v . CXX . 0\-t- 1 . 2112. 1022 NE 91 Terr. Miami Shores, Florida 33138-3402 RE: Work Without Permit Jennifer Jordan 1022 NE 91 Terr. Miami Shores, Florida 33138-3402 FOLIO: 11-3205-001-0300 Legal Description: Westersedge PB 9-141, lot 3 & E15 ft. Lot 2 BLK 2 YOU ARE HEREBY NOTIFIED that an inspection of the above premises revealed that you have violated the provisions of the Florida Building Code which have been adopted as the uniform building code for Miami Shores Village, Florida or provisions of the Code of Miami -Dade County. Type of Violation: Building, Electrical, Mechanical, and Plumbing. Chapter: 1 Section: 105.1 of the 5th Edition of the 2014 Florida Building Code To Witt: Failure to obtain permits for interior renovation and garage enclosure. REQUIREMENTS FOR CORRECTION Provide plans with details and specifications as required under section 107.2 of the 5TH Edition of the 2014 Florida Building Code and chapter 8-10 of the Miami Dade County Code. The scope of work should be approved by outside agencies and by the Miami Shores Village Planning and Zoning. Therefore, you are hereby directed that on or before Monday, April 11, 2016 you are to correct said VIOLATION and NOTIFY THE UNDERSIGNED BUILDING INSPECTOR that the VIOLATION has been corrected. Failure to make the correction(s) will result in one or more of the following actions: Disconnect utilities services, issuance of a ticket(s) in the amount of $500.00 or more, rU r-1 rU Q r-1 O `7001 2510 fling of a civil suit or criminal charges against you or initiation of an unsafe structures case requiring demolition of the structure. Also, failure to comply with this notice may result in the department withholding issuance of other permits to you, referral of this matter to the appropriate licensing board or the filing of a lien against your property in the amount of any unpaid ticketing fines. In accordance with the provisions of Section 8-17 of the Code of Miami -Dade County, you are also responsible for the reasonable costs and expenses incurred by the Building Official in enforcing the provisions of the Building Code. In the event further clarification or assistance is required, please contact Ismael Naranjo, B.O at (305) 795-2204 between the hours of 8:30 A.M. and 5:00 PM. Except in the case of life -safety hazards, you may be granted upon request an extension of time up to 90 days to correct the violation provided your request is submitted prior to the expiration of this Notice of Violation and enforcement costs incurred by the department to date are paid in full. To request an extension, please contact the Building Department by telephone at (305) 795-2207 or by e-mail to naranjoi@miamishoresvillage.com. Thank-fveyeur cooperation in this matter. "VOA' Ismael Naranjo, B.O Building Director. Mail By: Date Mailed: I Zt l . Posted By: Return Receipt Number: Date Posted: CC: Mr. Elrod Phillips, CEO Eltec Construction & Investment Liquidation Group, 2400 NW 98th St. Miami, Florida 33147 **-100 •2Sto.OL0%.•=cc.r41.2(31°i U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) Postage Certified Fee Return Receipt Fee (Endorsement Required) Restricted DeliveryFee (Endorsement Required) Total Postage & Fees Sent T S ir.NN t GRa- S-0« as--' Postmark Here or PO Box No. 102,2_ 1 + Eart. Street, Apt. No.; ty, Stat tL � 3 — l,�j�`. 3.31See Reverse tor Instructions PS Form 3800, January 2001 U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) OFFICIL771111111111111117.1 SS Postage Certified Fee Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) Total Postage & Fees Postmark Here Sent To (.716C.. C-or.S-tar.- t t0v Street, Apt. c 1 orr PO O Box No. o. AU _\ (J �+V ce J City, Stet; \i UNITED STATES POSTAL SERVICE First -Class Mail Postage & Fees Paid USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N.E 2 AVENUE MIAMI SHORES, FL 33138 i11111ii111111iii11ili iliiililiiiiiiiiiii 11111101111,111111111 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. • Print your name and address on the reverse so that we can return the card to you. • Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: —STENr-F — -V ea.. 47171z o--� Aert t %..--tom 3? 1 - 3L102 r2c_ i4- \1/442o 2. Article Number 7001: 2 510 0001'0841 2.11'2 (Transfer from send ' , ..• . A. Sign X ture B. Recq►ved by ( Printed Name) ❑ Agent ❑ Addressee cifiCk2f3eteli D. Is delivery address different from item 1? 0 Yes If YES, enter delivery address below: ❑ No 3. Service Type ISECertifled Mail 0 Express Mail ❑ Registered *Return Receipt ®Idi7it i/iw ❑ Insured Mail 0 C.O.D. 4. Restricted Delivery? (Extra Fee) 0 Yes • LA11' BUILDING PE MIT APPLICATION BUILDING ❑ ELECTRIC ❑PLUMBING JOB ADDRESS: Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑ ROOFING Master Permit No. RECEIV ED APR 041011 51-1 FBC 201L4 Rc -ice-gtct Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION CONTRACTOR Io 2Z. NE- `(► T ESR-RAc€- ❑ RENEWAL ❑ SHOP DRAWINGS City: Miami Shores Folio/Parcel#: Occupancy Type: Load: County: 11 -32 - co 0.gej Miami Dade Zip: OWNER: Name (Fee Simple Titleholder): Address: IUZt NE Construction Type: J Eur t F-E-iZ 33138 Is the Building Historically Designated: Yes NO Flood Zone: BFE: FFE: Jc 7R of %Si � E�(ZALFs Phone#: 384-98!o - 94 4. o City: I -AA A *AA 5 14cR-e-Sm State: f -t-- Zip: 371 3-3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: t .LT ' Address: Co ►.1 STRu (ZI o ri 2400 1.iu3 Phone#: 3Z6 - SS - 2-° 2-1 City: t..A\P. -A State: El_ Zip: 33 I y-1 Qualifier Name: �'.# t Phone#: State Certification or Registration #: C. G C. I S i i 5 8 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ `1 i Type of Work: ❑ Addition Description of Work: Square/Linear Footage of Work: Alteration ❑ New ❑ Repair/Replace ❑ Demolition N4. ?--r..-i 14.17-c..6.6. rOQ1( - R , \Li -1(47,0 Specify color of color thru tile: Submittal Fee $ Permit Fee $ k 0 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ 5 . OD Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE$ L4• LI 0 (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seve day . fter the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a rei spection fee ill be charged. Signatur OWNER or AGENT The foregoing instrument was acknowledged before me this 7t day of U M 17Cr,Qr441 ri , 20 / 7 , by , who is personally knownto me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: DANA A. NILSON , :.: Commission # FF 168600 vs, J Expires February 14, 2019 ,P,.... `: BonddTNuTroy Fin WIMP 81:0164Oti Signature ��!�i�--� CONTRAC •R The foregoing LI instrument was acknowledged before me this day of twa f �" 1 ''� , 20 t4 , by 6\ Y Ot 4\ 111 t —So is personally known to me or who has produced PUtz-Z,0I-c2c2- cp-o Ip r c�G identification and who did take an oath. NOTARY PUBLIC. Sig Print: Seal: • ..AFI ▪ ,i. MY COMMISSION # GG 044602 i: o ?P• Bonded Thru Notary Public Underwriters ***************************** **************************************************************s********** APPROVED BY (Revised02/24/2014) //f7/) Plans Examiner Zoning Structural Review Clerk